Malrotation of Long Bones

Sullivan, Michael P.; Bonilla, Kelsey; Donegan, Derek J.

doi:10.1016/j.ocl.2021.03.008

Cited by 4 publications

(3 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We hope the data from this study could help to improve the accuracy of surgical navigation systems for total hip arthroplasty (THA) or in the diagnostic work-up of patients with instability after THA, as femoral torsion affects the risk of dislocation and range of motion [38]. Van Correct assessment of femoral torsion is also important when considering a femoral derotational osteotomy, for example in young adults with hip pain due to excessive femoral antetorsion or retrotorsion [4,26], or in patients with malrotation after a diaphyseal femur fracture [24,36].…”

Section: Discussionmentioning

confidence: 99%

The quest for optimal femoral torsion angle measurements: a comparative advanced 3D study defining the femoral neck axis

Van fraeyenhove,

Verhaegen,

Grammens

et al. 2023

J. exp. orthop.

View full text Add to dashboard Cite

Purpose There is high variability in femoral torsion, measured on two-dimensional (2D) computed tomography (CT) scans. The aim of this study was to find a reliable three-dimensional (3D) femoral torsion measurement method, assess the influence of CAM deformity on femoral torsion measurement, and to promote awareness for the used measurement method. Methods 3D models of 102 dry femur specimens were divided into a CAM and non-CAM group. Femoral torsion was measured by one 2D-CT method described by Murphy et al. (method 0) and five 3D methods. The 3D methods differed in strategies to define the femoral neck axis. Method 1 is based on an elliptical least-square fit at the middle of the femoral neck. Methods 2 and 3 defined the centre of mass of the entire femoral neck and of the most cylindrical part, respectively. Methods 4 and 5 were based on the intersection of the femoral neck with a 25% and 40% enlarged best fit sphere of the femoral head. Results 3D methods resulted in higher femoral torsion measures than the 2D method; the mean torsion for method 0 was 8.12° ± 7.30°, compared to 9.93° ± 8.24° (p < 0.001), 13.21° ± 8.60° (p < 0.001), 8.21° ± 7.64° (p = 1.00), 9.53° ± 7.87° (p < 0.001) and 10.46° ± 7.83° (p < 0.001) for methods 1 to 5 respectively. In the presence of a CAM, torsion measured with method 4 is consistently smaller than measured with method 5. Conclusion 2D measurement might underestimate true femoral torsion and there is a difference up to 5°. There is a tendency for a higher mean torsion in hips with a CAM deformity. Methods 4 and 5 are the most robust techniques. However, method 4 might underestimate femoral torsion if a CAM deformity is present. Since method 5 is independent of a CAM deformity, it is the preferred technique to define expected values of torsion.

show abstract

Section: Discussionmentioning

confidence: 99%

The quest for optimal femoral torsion angle measurements: a comparative advanced 3D study defining the femoral neck axis

Van fraeyenhove,

Verhaegen,

Grammens

et al. 2023

J. exp. orthop.

View full text Add to dashboard Cite

show abstract

“…It may not be suitable for fractures requiring intricate anatomical reduction [ 18 ]. Furthermore, improper insertion or inadequate rotational control during intramedullary nail fixation can result in malrotation of bone fragments, potentially leading to functional issues or cosmetic deformities [ 19 ]. In the present study, we found that the incidence of postoperative complications was lower in the intramedullary nail group than in the plate fixation group.…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Intramedullary Nail versus Plate Fixation for Fibula Fracture in Supination External Rotation Type IV Ankle Injury

Chen,

Li,

et al. 2023

Med Sci Monit

View full text Add to dashboard Cite

Background Lateral malleolus fractures, typically from trauma, sports, or accidents, are common, with supination external rotation (SER) injuries being most prevalent. SER injuries involve complex joint mechanics and often necessitate surgical intervention for instability. This study compares intramedullary nail and plate fixation for fibula fractures in SER type IV ankle injuries, considering their biomechanical properties and influence on fracture healing. Material/Methods A prospective, randomized study was conducted between January 2021 and December 2021. A total of 81 patients with SER injuries were included in the study. Surgical procedures were performed using either intramedullary nails or plates. The following parameters were recorded and analyzed: postoperative complications, operation times, bone healing times, American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS) scores for pain, and ankle range of motion. Results Out of the 81 cases, 42 were treated with intramedullary nails, while 39 received plate fixation. Statistical analysis revealed a significantly lower rate of postoperative complications in the intramedullary nail group than in the the plate fixation group (9.52% vs 30.77%, P <0.0164). However, there were no significant differences between the 2 groups in terms of operation time, bone healing time, AOFAS scores, VAS scores, and functional evaluations ( P >0.05). Conclusions Plate fixation and intramedullary nail fixation are effective techniques for treating fibula fractures in SER type IV injuries. However, intramedullary nail fixation demonstrates a lower rate of complications. Therefore, intramedullary nails may be preferable to plate fixation for the management of fibula fractures in SER type IV ankle injuries.

show abstract

“…In the current study, we reported an incidence of malrotation of 48.5%, which is slightly higher than what is reported in the literature. Furthermore, most of the deformities (84.8%) were in external rotation, although we did not investigate the predisposing factors; this could be attributed to the muscle forces working around the fracture, about 52% of the included patients were obese or overweight, operating in a supine position, and not using a traction table [ 5 , 6 , 23 ]. However, we cannot deny possible surgical technique issues predisposing to the deformity, specifically using manual traction to maintain the reduction till final fixation [ 5 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical versus radiological method for adjusting rotational alignment during femoral shaft fractures intramedullary nailing and the malrotation impact on the functional outcomes: early results from a prospective cohort study

Abbas,

Khalifa,

Abubeih

et al. 2023

J Orthop Surg Res

View full text Add to dashboard Cite

Objectives The primary objective of the current study is to assess which is better for obtaining the proper femoral rotation during IMN of femoral fractures, the radiological or clinical method. The secondary objectives were to document malrotation's incidence and its effect on the hip and knee functional outcomes. Methods Thirty-three patients with unilateral femoral shaft fractures were treated using intramedullary nails (IMN) on a usual radiolucent operative table. Intraoperative rotation adjustment was performed using a radiological method (relying on the contralateral lesser trochanter profile) in 16 patients (group A), while in 17 patients, a clinical method was used (group B). Postoperative assessment of malrotation was performed using a CT scan, and 15 degrees was the cutoff value where below is an acceptable rotation (group I) and above is true malrotation (group II). Functional assessment was performed using the Harris hip score (HHS), the Tegner Lysholm Knee Scoring Scale (TLKSS), and the Neer score. Results The patients' mean age was 30.7 ± 9.3 years; 81.8% were males, and the left side was injured in 63.6% of patients. After a mean follow up of 18.2 ± 6.9 months, all fractures were united, and the overall mean amount of rotational difference between the fractured and the contralateral side was 14.7° ± 6.0 (3–29.4), 84.8% were in external rotation. No difference in the mean rotational deformity in group A compared to group B. Measurements were 13.9 ± 6.7 and 15.7 ± 5.5, respectively (p = 0.47). Seventeen (51.5%) patients in group I with a mean deformity of 9.8 ± 3.4 (3–14.7), while group II consisted of 16 (48.5%) patients with a mean deformity of 19.6 ± 3.7 (15.3–29.4). There was no difference in the functional scores between group I and group II; HHS was 89.4 ± 7.4 versus 87.7 ± 8.9 (p = 0.54), TLKSS was 84.6 ± 9.6 versus 80.4 ± 13.9 (p = 0.32), and Neer score was 87.9 ± 9.5 versus 83 ± 12.5 (p = 0.21) for group I and group II, respectively. Conclusion There was no difference in malrotation incidence after unilateral femoral fractures IMN with either an intraoperative clinical or radiological method for rotational adjustment; furthermore, malrotation did not affect the functional outcomes.

show abstract

Malrotation of Long Bones

Cited by 4 publications

References 45 publications

The quest for optimal femoral torsion angle measurements: a comparative advanced 3D study defining the femoral neck axis

The quest for optimal femoral torsion angle measurements: a comparative advanced 3D study defining the femoral neck axis

Comparative Analysis of Intramedullary Nail versus Plate Fixation for Fibula Fracture in Supination External Rotation Type IV Ankle Injury

Clinical versus radiological method for adjusting rotational alignment during femoral shaft fractures intramedullary nailing and the malrotation impact on the functional outcomes: early results from a prospective cohort study

Contact Info

Product

Resources

About